A new 184-bed private hospital is about to open in London, the second-largest in the capital, where patients will enjoy views of Buckingham Palace and will be treated by doctors understood to be paid up to £350,000 a year.
It provides a stark contrast with the NHS, which is buckling under the strain of record waiting lists, backlogs for cancer care and routine operations and a resurgence of Covid cases that is putting pressure on wards and staffing.
The opening of the Ohio-based Cleveland Clinic’s first London hospital at the end of this month comes at a time when the private health sector is booming. With 29 intensive care unit beds and eight operating theatres staffed by 1,200 people, the eight-storey site – estimated by analysts to have cost £1bn – will add to concerns about the emergence of a two-tier healthcare system.
Among London’s 19 private hospitals, it will be second biggest after the Wellington hospital in St John’s Wood, which is run by the US company HCA.
Specialising in neurology, cardiology, orthopaedics and digestive care, the new hospital boasts a neurosurgical operating theatre twice the usual size, with an MRI scanner in the room beside it – allowing the surgeon to wheel a patient over during an operation to check whether a brain tumour or other abnormalities have been completely removed.
In most other hospitals, more surgery is required when further abnormalities are discovered in the weeks after an operation. The NHS National Hospital for Neurology and Neurosurgery in Bloomsbury, central London, and other NHS hospitals around the country, for example in Sheffield and Nottingham, also have an intra-operative MRI set-up.
Unlike other British hospitals, Cleveland Clinic London has a pharmacy robot that laser-cuts strips of tablets into single doses and adds a barcode. These are then administered to patients via automated dispensing cabinets, with the aim of reducing errors and wastage.
About 270 consultants will be working at the new site, the vast majority of whom also work for the NHS, and will typically spend one to two days a week at the clinic. The company has reportedly offered most of them fixed salaries of up to £350,000 a year, rather than the fee-per-service basis common in the private sector, triggering a recruitment war.
Generally, the private sector’s fees for “rain makers” – top-level consultants – resemble “football-level salaries”, according to Ted Townsend, an analyst at the London-based consultancy LaingBuisson. Some earn up to £500,000 a year from a combination of private and NHS pay, clinical excellence awards and professorships, he said.
The new hospital will also employ 450 nurses, with more than half coming from other private operators or from Cleveland Clinic’s hospitals in Abu Dhabi and Cleveland, with the rest having moved over from the NHS, which employs 300,000 overall and is facing nursing staff shortages.
The company’s chief executive, Tom Mihaljevic, who flew over from Ohio for the unveiling of the new hospital, joked that it would not charge extra for its rooms with a view of Buckingham Palace. He said: “We take care of very complex and sick patients. People come to Cleveland Clinic when they run out of hope.”
While targeting UK patients with private health insurance or the growing number of people who are paying for treatment themselves, along with overseas patients, the Cleveland Clinic London is also in talks about providing complex procedures for NHS patients to help reduce waiting lists.
Brian Donley, an orthopaedic surgeon who is now chief executive of the clinic, said: “We are in those discussions with all different parts of London, with different NHS trusts on how we can support [reducing] that backlog. We do expect to see some NHS patients, in particular around complex care, in particular around diagnostics.” A spokesperson said these would mainly be tests for heart disease.
A number of London NHS trusts have come to rely more on the private sector during the pandemic. HCA, which has six London hospitals, provided an unprecedented amount of cancer care, cardiology and other services to several NHS trusts in the capital last year.
David Rowland, the director of the thinktank Centre for Health and the Public Interest, said: “The worry is the two-tier health system. London has always been the centre of the private hospital market. An estimated £1bn investment in a single hospital is a sign of how strongly foreign investors are betting against the NHS being able to meet the future health needs of the population. And the government seems entirely relaxed about this shift.”
Rowland added that “the pulling away of NHS consultants and nurses is problematic. Private companies are paying significantly more.” He pointed to ophthalmology, where growing numbers of consultants are leaving NHS jobs to join large private companies.
Cleveland Clinic is partly banking on the return to London of overseas patients – known as “embassy patients” as foreign embassies often pay for their treatment. They have been slow to come back since the pandemic, but travel restrictions to the UK have now been relaxed by Abu Dhabi, Dubai and Qatar – all leading sources of private patients.
The US group, which has 22 hospitals and 226 outpatient centres globally, was founded in 1921 as a non-profit group and has no shareholders, which means profits are ploughed back into the business, in a similar way to the British health companies Bupa and Nuffield Health.
The private sector has been criticised for using consultants and nurses that have been trained by the NHS, paid for by the UK taxpayer. Cleveland Clinic is trying to address this and has partnerships to train 150 student nurses, and to host neurology PhD students in its hospital. It will also let junior NHS doctors work there to gain expertise, its chief commercial officer, Will Rowberry, said.
• This article was amended on 17 March 2022. An earlier version incorrectly said the National Hospital for Neurology and Neurosurgery in Bloomsbury was the only NHS hospital with an intra-operative MRI set-up.
